血浆纤维蛋白单体水平与胃肠道恶性肿瘤患者疾病进展和预后的相关性

Relationship between the level of plasma fibrin monomer(FM)and disease progression and prognosis in patients with gastrointestinal cancer

目的:通过定量检测胃肠道恶性肿瘤患者血浆中的纤维蛋白单体(fibrin monomer,FM)水平来判断其是否与疾病进展和预后相关。方法:本研究选取自2015年1月至2016年3月就诊于我院的胃肠道恶性肿瘤患者。根据FM的参考范围,将患者分为正常组(FM≤6μg/ml)和异常组(FM>6μg/ml)。采用Kaplan-Meier方法对癌症特异性生存率(cancer specific survival,CSS)进行了3年回顾性随访分析。本研究还利用Cox回归分析评价肿瘤预后因素,同时建立了诺模图模型来预测FM对肿瘤患者预后的影响。结果:在本研究中异常组和正常组的比例分别为40.1%(63例)和59.9%(94例)。基于FM的临床和实验室数据分析得出,两组患者无年龄和性别差异,但在肿瘤的分化程度、T分期以及PLT、FIB、DD等指标上的差异具有统计学意义。单因素分析发现FM正常组和异常组的3年生存率有显著统计学差异(分别为72.3%和42.9%,P=0.003)。通过多因素生存分析,我们确定FM可以作为胃肠道恶性肿瘤患者的独立预后因素(P<0.05)。用来预测FM对肿瘤预后影响的诺模图显示其受试者操作特征曲线(ROC)下的面积AUC为0.779(95%CI:0.706~0.853),敏感性和特异性分别为67.7%和79.0%。结论:这项研究表明,FM与胃肠道恶性肿瘤的进展及预后密切相关。高水平的FM提示患者预后不良,生存期短。

Objective:To quantitatively measure the level of plasma fibrin monomer(FM)in patients with gastrointestinal cancer to determine whether it is related to disease progression and prognosis.Methods:The subjects of this study were patients with malignant gastrointestinal cancer who were admitted to the hospital from January 2015 to March 2016.According to the reference range of FM,the patients were categorized into two groups:Normal(FM≤6μg/ml)and abnormal(FM>6μg/ml).A retrospective 3-year follow-up was carried out to study cancer specific survival(CSS)by using the Kaplan-Meier method.Prognostic factors of tumors were assessed through the Cox regression analysis.A nomogram model was also produced to predict the effect of FM on tumor prognosis.Results:The abnormal group accounted for 40.1%(63 patients)of the total in our study and the normal group was 59.9%(94 patients).Based on the clinical and laboratory characteristics of FM,there were no differences in age and gender between the two groups,but there were statistically significant differences in tumor differentiation,T stage,PLT,FIB,DD and other laboratory indicators.The difference of 3-year survival rate between normal group and abnormal group was statistically significant by single factor analysis(72.3%vs 42.9%,P=0.003).By multivariate survival analysis,we determined that FM was an independent prognostic factor for patients with gastrointestinal cancer(P<0.05).The nomogram used to predict the effect of FM on tumor prognosis showed that the area AUC under ROC was 0.779(95%CI:0.706~0.853),with a sensitivity and specificity of 67.7%and 79.0%,respectively.Conclusion:This study shows that FM is closely related to the progression and prognosis of gastrointestinal cancer.High level of FM indicates poor prognosis and short survival.